Tesis

Penggunaan Ultrasonografi untuk Konfirmasi Tip Peripheraly Inserted Central Catheter Dibandingkan dengan Radiografi Standar = The Use of Ultrasound to Confirm Tip of Peripherally Inserted Central Catheters Compared to Standard Radiograph.

Latar Belakang. Penggunaan peripherally inserted central catheter (PICC) semakin meningkat sesuai kebutuhan bayi prematur dalam pemberian nutrisi parenteral. Penggunaan radiografi standar (Rontgen torako abdomen) dalam menilai posisi tip PICC yang tepat merupakan baku emas. Namun demikian, radiografi standar tidak selalu akurat dalam memperkirakan posisi tip PICC, tergantung pada posisi ekstremitas dan variasi anatomi masing-masing neonatus, menyebabkan radiasi, membutuhkan biaya yang lebih tinggi, waktu yang lebih lama dan membutuhkan pemeriksaan ulangan apabila posisi tip PICC terlalu dalam masuk ke jantung. Ultrasonografi (USG) semakin banyak digunakan untuk diagnostik dan prosedur di neonatal intensive care unit (NICU) karena lebih mudah, aman, murah dan real-time. Tujuan. Penelitian ini bertujuan untuk menilai akurasi penggunaan USG dalam menentukan ketepatan posisi tip PICC dibandingkan dengan radiografi standar. Metode. Penelitian ini merupakan studi diagnostik yang dilakukan pada bulan April-Mei 2017 di NICU. Pemasangan PICC menggunakan prosedur standar di NICU dan kemudian posisi tip PICC dievaluasi menggunakan USG sebelum dilakukan radiografi standar. Analisis menggunakan table 2x2 untuk menilai akurasi diagnostik USG dibandingkan radiografi standar dalam menilai posisi tip PICC. Hasil. Sebanyak 29 neonatus termasuk dalam penelitian ini dengan rerata usia gestasi 31,7 minggu (26 sampai 41 minggu) dan rerata berat lahir 1618,9 g (600 sampai 3750 g). Kesesuaian antara radiografi standar dan ultrasonografi untuk posisi tip PICC terjadi pada 27 neonatus (93,1%). Sensitivitas ultrasonografi dalam menentukan tip PICC adalah 88,89%, dengan spesifisitas 95% dan ultrasonografi memiliki akurasi diagnostik 93,1%. Simpulan. USG memiliki akurasi diagnostik yang baik untuk mengindentifikasi posisi tip PICC, meminimalkan paparan radiasi dan meminimalkan manipulasi PICC di NICU.
Kata kunci: USG, Radiografi, PICC, Neonatus, NICU


Background. The use of peripherally inserted central catheter (PICC) has became increasingly common to facilitate the administration of parenteral nutrition in preterm neonates. The use of standard radiograph (X-ray of the abdominal thorax) in assessing the correct position of peripherally inserted central catheter (PICC) line tips is a gold standard. However, standard radiograph can not always be accurate depending on the position of the extremities and variations of anatomy of each neonates, cause radiation, require higher cost, longer time and repeat when position is not appropriate. Ultrasound are becoming increasingly use for diagnostic and procedure in neonatal intensive care unit (NICU) because more easy, safer, cheaper, and real-time. Objectives. This study aims to assess the accuracy of ultrasound use in determining the accuracy of PICC tip positions compared to standard radiograph. Methods. This was a diagnostic study to examine the placement of PICC in neonates between April and May 2017 in NICU. PICC were placed using standard procedure in NICU and then position of PICC tip were evaluated using ultrasound immediately before standard radiograph is performed. A 2x2 table was constructed to compare the two modalities ability to detect tip PICC position. Results. A total of 29 neonates were included in this study with mean of gestation of 31.7 weeks (26 to 41 weeks) and mean of birth weight 1618.9 g (600 to 3750 g). Concordance between standard radiograph and ultrasound for PICC tip position occurred in 27 neonates (93.1%). Sensitivity of ultrasound in determining PICC tip was 88.89%, with a specificity of 95% and ultrasound had a diagnostic accuracy 93.1%. Conclusion. Ultrasound has a good diagnostic accuracy to indentify tip position of PICC, minimizing exposure of radiation and minimize manipulation of PICC in NICU.
Keywords: Ultrasound, Radiograph, PICC, Neonates, NICU